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Query: UMLS:C0038220 (status epilepticus)
 7,272 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although rare, status epilepticus refractory to conventional therapy may require the initiation of pentobarbital anesthesia and intensive monitoring in the PACU. Barbiturate therapy mandates that the nurse be able to perform mechanical ventilation and advanced cardiopulmonary monitoring as well as be familiar with electroencephalographic monitoring. Careful attention to the potential side effects of barbiturate therapy and anticipation of end-organ complications can increase the likelihood of seizure termination and recovery of status epilepticus patients.
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PMID:Barbiturate therapy for status epilepticus in the postanesthesia care unit. 770 57

Six hundred and ninety-four members of the Intensive Care Society working in the UK were surveyed by postal questionnaire between May and November 1993 to determine their management of convulsive status epilepticus resistant to initial therapy with intravenous diazepam and phenytoin. Four hundred and eight forms were completed and returned (58.8%). The survey revealed that, following failure of initial management, a benzodiazepine infusion (35%) or anaesthetic induction agent (32%) were the preferred second lines of treatment in intensive care units. In paediatric intensive care units, phenobarbitone (31%) was the agent of choice. Most respondents (57%) gave anaesthetic induction agents within 60 min of the start of status epilepticus, the majority choosing thiopentone (82%). Patients were usually monitored using clinical assessment only (45%), except in paediatric intensive care units and specialist neurological or neurosurgical units where the majority used a cerebral function monitor. Only 12% of the respondents were aware of a protocol for status epilepticus in their intensive care units. The most frequently used therapeutic and monitoring strategies in the management of refractory status epilepticus in the UK are insufficient and need re-evaluation.
Anaesthesia 1995 Feb
PMID:The intensive care treatment of convulsive status epilepticus in the UK. Results of a national survey and recommendations. 757 81

So far propofol has only been used in clinical settings for sedation and induction of anaesthesia. This study describes several indications in preclinical and emergency events. All users were anaesthetists, so that experience of administration and dosage was extremely helpful. Since the drug met the expected criteria it is now regularly used for the sedation of ventilated patients during transport. The most important indications for preclinical induction of anesthesia with propofol are patients with isolated head injury and patients with respiratory insufficiency due to status asthmaticus resistant to therapy. After repeated unsuccessful attempts at therapeutic intervention with benzodiazepines and other antiepileptics we were able to interrupt status epilepticus in 11 patients by means of propofol, thereby preventing the patient from being intubated as a consequence of iatrogenic respiratory failure. However, emergency doctors must always be aware of the severe cardiocirculatory side effects of the drug, and must, hence, ensure that hypovolaemia or cardiac failure is excluded or corrected prior to propofol administration.
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PMID:[Propofol in emergency care--areas of application and initial experiences]. 781 Jan 46

Barbiturate anaesthesia is used in the treatment of status epilepticus and severe epilepsy of children. EEG is then used as a measure of the depth of anaesthesia, burst suppression being an easily identified EEG pattern. In this case report we describe epileptiform discharges during EEG suppression in two children undergoing barbiturate anaesthesia for treatment of intractable seizures. One of them had focal, rhythmic discharges of negative spikes on the positive suppression level. Bursts were readily produced by visual stimuli with flashes of red light but this did not increase the frequency of focal spike discharges after bursts. The other patient had generalised, high amplitude spike-wave complexes, which were easy to distinguish from the bursts. We emphasise that it is important to make a distinction between electrocerebral silence, or isoelectric EEG as it was previously called, from EEG suppression. It is also important to distinguish epileptiform discharges from bursts, if the intention is to keep the anaesthesia at EEG burst suppression level.
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PMID:Epileptic EEG discharges during burst suppression. 788 40

The optimal therapeutic approach for the patient with refractory generalized status epilepticus remains to be defined. We describe four patients with refractory generalized status epilepticus who were successfully treated with intravenous midazolam. Each patient had prolonged convulsive status epilepticus unresponsive to standard doses of intravenous benzodiazepines, phenytoin, and phenobarbital. The patients subsequently received midazolam administered as an intravenous bolus (200 micrograms/kg) followed by a continuous infusion (0.75 to 11 micrograms/kg/min) lasting 8 hours to 10 days. Clinical examination and scalp electroencephalographic monitoring documented the cessation of seizure activity within minutes of the loading dose in all patients. No significant adverse effects occurred during midazolam treatment. The one patient with prolonged midazolam infusion required fluid boluses and pressors for moderate hypotension, and the remainder of the patients safely tolerated midazolam despite preexistent hemodynamic instability. All patients recovered and maintained good seizure control. Intravenous midazolam appears to be an effective treatment for refractory generalized status epilepticus, and may represent a substantial improvement over current therapeutic approaches such as pentobarbital anesthesia.
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PMID:Treatment of refractory generalized status epilepticus with continuous infusion of midazolam. 793 32

Significant advances in our understanding of the pathophysiology and evaluation and management of the patient in status epilepticus have markedly decreased associated morbidity and mortality in the last two decades. Any type of seizure can progress to status epilepticus. Identification and management of the cause is of particular importance for those patients for whom initial pharmacologic management fails. This subgroup of individuals tends to have important underlying metabolic, structural, toxic, or infectious causes that must be addressed. Those episodes associated with CNS pathology tend to have a more serious prognosis. Cause aside, appropriate, organized, and timely care will significantly effect outcome. Treatment goals are fourfold: (1) rapid stabilization of the individual, (2) expeditious termination of both clinical and electrical seizure activity, (3) determination and management of life-threatening precipitants, and (4) timely recognition and minimalization of any adverse physiologic sequelae of seizure activity. Benzodiazepines, phenytoin, and phenobarbital remain the most effective first-line and second-line pharmacologic agents. If these agents prove ineffective, appropriately monitored pentobarbital anesthesia appears to be the modality of choice and should be rapidly instituted.
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PMID:Management of status epilepticus. 795 92

We report our experience using lidocaine to determine the epileptic focus in a case of refractory status epilepticus associated with an aberrant intracranial shunt tube. Pentobarbital anesthesia rapidly suppressed convulsions. However, whenever the pentobarbital was decreased, the status epilepticus was resumed. The seizure looked primarily generalized both clinically and electroencephalographically, but EEG monitoring with intravenous administration of lidocaine demonstrated that the ictal waves began from the right anterotemporal area, where the shunt valve and tube were placed. Removal of the shunt tube and the surrounding scar tissue eliminated status epilepticus. Our result suggests the excellent efficacy of lidocaine to distinguish secondarily generalized status epilepticus from primarily generalized one.
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PMID:[A case of refractory status epilepticus associated with aberrant intracranial shunt tube: efficacy of lidocaine in the determination of the epileptic focus]. 807 95

Propofol is a relatively new anesthetic agent used in outpatient surgery. Some investigators use it in the treatment of status epilepticus and in epilepsy surgery and have concluded that propofol has an anticonvulsant effect. Cases of seizure-like behaviors, myoclonus and opisthotonus following propofol anesthesia have been reported. Although rare, official warnings about this association have been issued. Different EEG abnormalities, and no abnormality, have been associated with propofol. We report a case of a healthy man who developed nonconvulsive seizures and generalized paroxysmal fast activity in his EEG following use of propofol for anesthesia.
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PMID:Propofol, seizures and generalized paroxysmal fast activity in the EEG. 808 14

Midazolam is a water-soluble benzodiazepine proven to be efficacious in sedation, hypnosis, and induction and maintenance of anesthesia. Because of its water solubility, it is a desirable drug for the control of status epilepticus when intravenous (IV) access is not obtainable. This study compares intramuscular (IM) versus IV routes of administration of midazolam in the control of tonic-clonic activity produced by chemically induced generalized seizures in a swine model. When midazolam was administered by IV route, tonic-clonic activity lasted a mean of 34 +/- 5.4 seconds, and when administered by IM route, the tonic-clonic activity lasted a mean of 116 +/- 41 seconds. Both were considerably abbreviated when compared with the expected duration of pentylenetetrazol-induced seizures in the swine model. Serum levels of midazolam achieved by the IV route were considerably higher than those achieved by the IM route. It is concluded that midazolam is effective in the control of tonic-clonic manifestations of generalized seizures when administered by the IV or the IM route and that no correlation exists between serum levels achieved and the time to control the seizure.
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PMID:Intravenous versus intramuscular midazolam in treatment of chemically induced generalized seizures in swine. 817 31

Frequent epileptic seizures in children are often related to delayed psychomotor development, and status epilepticus is always a neurological emergency. In both situations barbiturate anaesthesia has been used for status epilepticus since the 1960s, and for intractable seizures in children since the 1980s. However, the clinical results on the effectiveness of barbiturate anaesthesia in children with chronic epileptic disorders remain contradictory. Between 1986 and 1991 in Tampere University Hospital in Finland long barbiturate anaesthesia was introduced--using thiopentone sodium--to eight children with very severe epilepsy. Children were 10 months to 7 years 11 months of age and the mean time from the onset of seizures to the introduction of BA was 2 years 8 months. Effects upon seizure frequency, antiepileptic medication and/or psychomotor development were clearly positive in three patients, slightly positive in one patient and in four patients there was no effect. Good effect seemed to be associated with an anaesthesia which is deep and long enough to produce loss of consciousness and spontaneous reactions, and an electroencephalographic pattern of burst-suppression. Positive results were also more often achieved when the treatment lag was less than 12 months. Physical and neurophysiological properties of barbiturates make their effectiveness as anticonvulsants understandable, but there is only little evidence to explain the mechanism of this action.
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PMID:Effects of long barbiturate anaesthesia on eight children with severe epilepsy. 830 18


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